6 Things No One Tells You About Being a New Grad NP

Sigh. I'm turning 30 next month. I really don't feel like I'm ready to be quite that old! I can run 10 miles any given day of the week and I don't have too many forehead wrinkles (they're more like fine lines...). I've been to a dive bar with my grad student sister at least once in the past month, and I own a leather dress. Take that 30. But, as with any life transition there are changes, both welcome and feared, on the horizon for this new decade of my life.

The best way to tackle life's transitions is to be prepared. A little practicality and foresight can help you brace for the challenges you might face. It helps you keep perspective when the $@^&#* hits the fan and you feel like giving up. Life as a new grad nurse practitioner won't be easy. But, thinking through the coming months realistically will help you weather the storm. Here are a few truths to keep in mind.

In reality, the process of taking your NP certification exam, getting licensed, and looking for a job can take weeks or more likely months. Yes, that annoying girl who sits in the front row of your pharmacology class may have found a job immediately upon receiving her diploma but it doesn't happen to most people. Plan emotionally and financially for a months long job search process.

2. It's entirely possible you will hate your first job

As a new graduate nurse practitioner, your options are somewhat limited when it comes to finding a job. Most employers are looking for someone with experience. So, you take what you can get. Until you get a little experience and learn the reputation of employers in your area it's entirely possible you may end up in a less than desirable position. And that's OK. Use the opportunity to advance your clinical know how. Take note of any mistakes you made in signing your contract. Plan to stick out the situation for about a year so it serves as a resume booster rather than a detriment. Then, in 12 months put your experienced, knowledgable, and more confident self back on the job market.

3. Get out your checkbook- getting licensed and certified will cost you

I just renewed my DEA license. It cost $731. Talk about a hit to the bank account, even for someone who has been employed as an NP for over five years. A state nurse practitioner license will cost you a couple hundred bucks as well, not to mention the fee for taking your certification exam. Set aside $1,000 to $2,000 to put toward your certification, licensure, and job search (see a breakdown of projected expenses here). You don't want lack of a DEA number to preclude you from applying to certain jobs. The upside? Some employers will reimburse you for these costs.

4. You will be stressed beyond belief

OK, let's face it. You don't know what you are doing...yet. And, even when you do, your clinical decision making is clouded by a heavy fog of doubt. I asked about a million questions everyday in my first job. I'm not sure if the most stressful part of starting work as a nurse practitioner was worrying I was asking too many questions or the lack of knowledge that required me to do so.

When I first started working in the emergency department I literally had to give myself a pep talk on the way to work every afternoon. Some days I seriously contemplated missing the exit for the hospital and continuing to drive until I reached Kentucky and eventually Indiana where no one could find me. But, my cell doesn't work in Kentucky and Indiana winters are snowy so I dragged my behind to work and continued to ask question after question after question. Eventually the nerves subsided and I began to feel like I was good at my job.

5. Patients will notice you don't know what you are doing

Don't you hate when you go in a patient's room and they ask if you have experience doing the particular procedure you're about to perform? Now, I can respond confidently that "this is the fifth laceration I've sutured today", but as a new grad I likely could count the number of times I had performed said procedure on one hand. That is, if I could get my hands to stop shaking.

The good news? Most patients are quite understanding. Put on a smile and helpful attitude and they're willing to be gracious to you as well (old people and drunk people are particularly amenable to letting you get experience with your procedural skills). Provided you have a supervising NP or MD in the room if you need help, patients understand you are learning.

Remember, it's always better to ask than make a mistake. If you aren't sure or are not confident about something, ask! Trust me, your employer will be glad you did. Plan to pay it forward later in your career when you are training a new grad in the future.

6. You will be a boss

Like it or not, healthcare is a hierarchy. As a nurse practitioner, you land near the top of the clinical or hospital provider ladder, at least higher than you did as a nurse. In some clinics, nurse practitioners are even responsible for hiring (and firing) their own support staff. Unfortunately, most NP programs don't teach leadership skills.

It can be awkward as a nurse practitioner without experience, especially if you are young, to direct other hospital staff. As a new NP in the emergency department I found it difficult to navigate relationships with 60 year old male nurses who had been working in the department for years when I was suddenly in charge of directing their actions. Through trial and error and a lot of understanding on the part of nurses, phlebotomists, etc. I developed my own leadership style. This can be hard to develop and takes time. Don't be frustrated if you find these relationships tense or uncomfortable at first.

Life as a new grad nurse practitioner is a learning process to say the least. Be patient with yourself, your employer, and your coworkers. You will slowly become more comfortable in your practice and new position but it will take some time and it won't be easy. Stick out your first job learning everything you can. Remember, you can always reevaluate your employment situation in a few months and make changes in the future if necessary.

Comments

I wish I could find a way to handle when patients realize you are new to the practice and try to manipulate you into getting more medications. Or how to handle patients who dump their entire life history on you while you are just trying to get an HPI. I wind up listening to many social issues that neither can I fix or have absolutely no direct connection as to why they are there. Any tips?

LaVerne Washington

"Patients will notice you don't know what you are doing" Why is this just shrugged off? Why is this #5? Not knowing what you are doing, when you hold someone's life in your hands, is... do I really have to say it?

charles trant

I'm glad you find it appropriate to even joke about "old people and drunk people" being amenable to you practicing procedures. <sarcasm> both are vulnerable populations and drunk people can't consent. You would know that if you were an MD or DO. Shame on you.

C

I can tick off everything that was said here....Will be turning 40 this year...no current experience to get hired and not alot as a RN either as I put work and grad school on hold to raise a family. Now my resume is bleak...I have two specialties too...CNM and WHNP...I am a year out now and no luck...skills are waning and stressful dreams are nightly..

OA

I was curious to know if during this time of unemployment or looking for a job, did anyone consider working at a pharmacy walk-in clinic? Or doing this until they had more experience to put on their resume?

Mary Kathryn

This article is a mirror of what I am going through right now. I have been a nurse for almost 18 years. Finished NP school at the end of March, took my test in June and passed. Finally got my license in July and here it is September and I am still looking for a job. I also heard throughout my schooling how much NP's are in need. But, no one told me that every job wants experienced NP's. This is so frustrating. I am trying to stay positive. I think that part of the problem is, as an RN, jobs would call you back within a week, but NP jobs prospects take considerably longer, if they call you back at all.

Discouraged new grad

Yes, be prepared to look for a job for months. It has taken me 7 months to find a job here in Florida and even after that it is another 90 days to get credentialed so, I will have been unemployed for 12 months after looking for a job, taking my exam and getting all the paperwork in order. I am not allowed to have a DEA in Florida, but hopefully the state laws will be changing soon.

Tina Jordan

Try graduating in your 60s. It wasn't always easy but I know it was the right thing to do and enjoy working as a FNP every day. It did shock me the cost of the testing and licenses. Maybe we should have a national license, same as the certificate. In NY & NJ you need a current RN + NP license+ National certification + DEA $$$$$$$$$$ and to renew you need 150 or more CEUs $$$$$$$

Ellen Kaplan

There is no substitute for real life experience. Whether that is psycho-dynamics of the novice to expert in ones new role or just in practice. One can be humble and still have posture. I am in an NP program . I have been a nurse for 30 years. A young 52, I have a lot of confidence, but a keen observer of how those with less experience are a Midlevel and not listening to the patient or to me.
Here are two simple stories : patient keep saying his blood sugar is high and he knows how he feels. The accucheck kept reading low. Multiple machines, multiple checks. The blood work from lab still pending, provider ordered D50. I refused to give it be the pt refused. I felt it was assault if pt is refusing and Midlevel tried to cause a lot f trouble for this difficult nurse. You know I am going to tell you the patient and I were correct. His blood work form lab had him at over 500. D50 would have made his DKA worse.
What happened to quality controls on accucheck? Even though the strips were stored in a Pyxis, it gets hot against the wall and frankly in that whole ER. The fix was to move the whole accucheck and storage of strips to a cool med room. Not the less controlled Pyxis. I also had strips do the same weird thing when I was doing home care. Pat said she was low, low,low, she read high for me. She was sweaty and confused. It was a 78 degree day in San Clemente, Ca( beach with not much humidity). I drew blood to take to lab, but I let her drink juice and then told her to eat at least some cheese or protein and in 1 hour I could call her from lab with results. She was right.
This is a HUGE thing. So I share the story because of the dynamics bet the Midlevel, but also the second scenario because we enter the Summer and it is warmer than ever. The Whitehouse just talked last week about Heath concerns with warming trends. It is to offer that as we teach our clients and each other, be humble and be aware.

Sondra Lee

It's all worse than that.
Doesn't seem to be a shortage..

Something PMH-NPs aren't told is this: 3/4 of your internships during grad school program are psychotherapy. You will NEVER be allowed to see a patient for psychotherapy, NEVER. Not EVEN when you get certified in CBT, or certified form another school of therapy. Unless, of course, you set up your own private practice. See, med mgt only pays more than psychotherapy: the psychiatrist boss wants you to see 4-5 patients an HOUR.

As a PMH-NP, your first job may be a contract for a temp agency, seeing pts you've never met, for 7-12 minutes, prescribing and getting psych patients out the door. Paid per patient, about 40% of reimbursements - but then it becomes less, because you have to stay after to chart, about 3-4 more hours. Brings your wage below RN.

You have to know what YOUR state is doing. In Michigan, for example, APRNs are running for other states. Michigan is destroying the profession of NP with Senate Bill 68, making it illegal for an APRN to EVER own any for-profit entity, must have constant physician supervision, are not considered "professionals" and APRN not a "profession" (It's just a job you do, for the profiteering of the physicians, in MIchigan law if this passes).....must have FOUR years of scut-work at low pay (not just 2 years like other states) under collaboration plus mentorship plus supervision (and you pay for all three), and
If you EVER are unlucky enough to have a malpractice or disciplinary action against you, and can't prove in court that you were under supervision when you did/didn't do the cause of the case, YOU WILL BE HELD TO THE STANDARDS OF A PHYSICIAN - NOT the standards of your own profession. There's more going on than that.